Year Book: Unstable Colles' Fractures in Elderly Patients: A Randomised

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Trial of External Fixation for Redisplacement. Roumen, RMH. Hesp, WLEM. Bruggink, EDM. Canisius Wilhelmina Hosp, Nijmegen, The Netherlands. Abstract/Commentary:|1992 Year Book of Hand Surgery. Article 9-13.|Original Article:|J Bone Joint Surg. 1991. 73-B. pp 307-311.. Background.--Although Colles' fracture is a common injury, there is no consensus on whether conservative management or surgical treatment should be used. Results may differ according to the age of the patient. The functional results of secondary reduction and external fixation were compared with those of accepting the displaced position in elderly patients. Methods.--A total of 126 consecutive patients older than 55 years of age who sustained Colles' fracture in a simple fall were studied. The mean age of the 93 women and 8 men for whom complete data were available was 70 years. In all patients, the fracture was reduced under local anesthesia within 6 hours of the injury. After 2 weeks, the patients with dorsal angulation of more than 10 degrees or radial shortening of more than 5 mm more than that of the opposite wrist were assigned randomly to either an external fixation group or a control group, in which plaster treatment was continued. Those in the external fixation group underwent remanipulation and application of an Ace Colles Fixator. Patients whose dorsal angulation was 10 degrees or less and radial shortening was 5 mm or less compared to the opposite wrist after 2 weeks were assigned to the primary group and remained in their current plaster. Results.--The anatomical end results, based on a score of 1 for excellent through 4 for poor, were 2.07 for the primary group, 1.95 for the external fixation group, and 3.4 for the control group. More than one third of the patients had some persisting pain at 26 weeks. Conclusions.--Although patients treated with external fixation had a good anatomical result, their function was no better than that of the control group. No correlation was discovered between final anatomical and functional outcome in these elderly patients. Because the severity and complications of the original soft tissue injury are the major determinants of functional outcome, emphasis should probably be placed i this area.